Tansneem Bhatia, MD, (aka Dr. Taz), medical director and founder, the Atlanta Center for Holistic & Integrative Medicine
Obesity, like alcoholism, depression, and anxiety, is a disease. There are definite medical patterns: hormone imbalances, neurotransmitter deficiencies and nutritional exhaustion that all contribute to obesity. Many of my patients that are obese have underlying medical issues that need to be addressed.
I agree that there are behavior patterns that contribute to obesity, but these same behavior patterns are rooted in other biological factors. Stress, the standard American diet and the industrialization of food have all been blamed in the obesity epidemic. While all of these factors contribute to being obese, they also create critical biological imbalances that people cannot overcome, or do not have the tools or knowledge to understand how to change.
Diets and exercise regimens often fail simply because the underlying medical pathology has not been addressed. My approach is to evaluate a patient fully, including family history, exhaustive hormone evaluation, nutrient status, and life inventory to understand where to begin in treating this disease. There is no quick weight loss for the obese.
Osama Hamdy, MD, PhD, medical director, Obesity Clinical Program; director, Inpatient Diabetes Management, Joslin Diabetes Center; and assistant professor of medicine, Harvard Medical School
Obesity is a disease. But what can define it? Most of the definition is based on the body mass index, and the body mass index is actually misleading. And using the body mass index to define obesity is a problem because someone like Arnold Schwarzenegger, for example, has very high body mass index and it’s all muscles. Because body mass index is calculation from the height and the weight. SO it doesn’t matter if the weight is muscles or the weight is fat. And in the same time, you can find some people with low body mass index that have a high percentage of body fat. So the true definition of obesity should be based on the amount of body fat in the body or the percentage of body fat. And we should use another surrogate marker for obesity definition like waistline, like intra abdominal fat, like center of visceral fat.
Science is science. Obesity is definitely a problem. It is a disease. But we have wrong definition right now for obesity. That’s the point. We need to define it much better.
David L. Katz, MD, MPH, director, Prevention Research Center; associate professor adjunct in public health, Yale University School of Medicine
In some ways, cataloging obesity as a disease is a way of conferring legitimacy: it is a condition, not a lapse in willpower; it warrants medical attention; it is worthy of insurance coverage. All of that is positive.
But I have never liked the idea of characterizing obesity as a disease, because disease occurs when the body is malfunctioning. Turning surplus calories into a fat reserve is not malfunction; it is normal physiology. Calling obesity a disease implies the body is malfunctioning, rather than the body politic.
We don't, for instance, label drowning a disease. It is, clearly, a legitimate medical condition—worthy of treatment and insurance coverage. But the fault lies with the situation, not with ourselves—in the sense that human bodies are simply not adapted to spend too much time under water.
Obesity is the same. It is rampant in the modern world not because of changes in our bodies, but because of changes in the modern world. The causes are all around us; we are drowning in them! We are drowning in excess calories and labor-saving technologies.
My preference would be to catalog obesity as a form of drowning—in calories rather than water—because that would combine medical legitimacy, with an appropriate focus on the environmental causes. To appreciate the danger of calling it a disease: consider an effort to develop drugs to treat drowning, rather than focusing on fences, lifeguards, and swimming lessons.
[pagebreak]
Marianne J. Legato, MD, professor of clinical medicine, Columbia University College of Physicians & Surgeons
When I read the AMA news, I skipped very lightly over the announcement that obesity was now an official disease—because it's too difficult to define what the term actually means for any given individual, much less to decipher in any one individual what causes and perpetuates it.
Obesity is a complex entity that can have many causes; some are endocrine (like thyroid malfunction or hyperfunctioning of the adrenal gland-Cushing's sydrome) but often the condition is from a combination of inactivity and overeating. For others, there are genetic factors that produce a tendency to overweight even with the consumption of what would be for most people an appropriate number of calories.
There is, to be sure, an important emotional component to overeating; often patients do it for comfort, out of habit, from boredom or for combating anxiety. Some use being obese as a defense against rejection: "It's just because I am fat that I am not promoted/have no significant other/have few intimate friendships." Overeating for some patients is a lifelong compulsion which is profoundly ingrained into their behavior. Many children are served inappropriate foods in much-too-large portions.
Counseling patients about their weight thus becomes very complex, because establishing the reasons for obesity and then helping patients cope with changing their lifestyle or correcting the illnesses that may be causing their overweight are not easy things for the practicing physician to do. To add to the difficulties, family members, believe it or not, may have an investment in keeping the patient overweight: the husband who becomes uneasy about the improvement in his wife's appearance, for example. Those family members may actually sabotage or neutralize the patient's effort to control and correct weight. Society's idea of what body size is acceptable may also be an important factor: watch British television—many of the female actresses would be classified as overweight by an American physician!
It really doesn't matter how the AMA or any other organization characterizes "obesity"—sorting out the causes and dealing with the incredibly complex task of leading a patient to a healthier and more functional state is not a trivial task. In short, it's a heterogeneous entity and all too often one of the hardest to correct. Whether the causes are hormonal, genetic or reside in the brain (its reward system or the circuitry that underlies habit, perception of portion size, the choice of food, etc.) is often difficult to sort out.
Mary Jane Minkin, MD, clinical professor of obstetrics, gynecology, and reproductive sciences, Yale University School of Medicine
If by defining it as a disease, then health care providers will be reimbursed for time spent counseling patients on proper nutrition, and exercise, and healthy life style habits, then I'm all in favor of it; I'd much rather see money spent on prevention than for therapy for all the adverse consequences.
However, I don't view obesity as a condition placed upon a person by God (like say for example Lupus—there isn't anything you can do to prevent lupus—if you're gonna get it, you unfortunately get it.) But everyone is capable of preventing obesity: if you eat properly and exercise properly, you don't become obese.
So that's why I am of a mixed opinion. And I don't really worry about the semantics: I have always counseled my patients on proper nutrition and exercise, and I will continue to do so, no matter what people call obesity; I want to prevent it.
[pagebreak]
Pam M. Peeke, MD, MPH, president, the Peeke Performance Center for Healthy Living; assistant clinical professor of medicine, University of Maryland
Overall, the decision by the AMA to designate obesity as a disease is progressive. Clearly using a BMI-based system is fraught with shortcomings, but the wealth of positive benefits to obese people of all ages far outweighs this problem.
Does obesity fit the strict definition of a disease? According to Mosby's Dictionary of Medicine, Nursing, & Health Professions, a disease is: 1. a condition of abnormal vital function involving any structure, part, or system of an organism; 2. a specific illness or disorder characterized by a recognizable set of signs and symptoms attributable to heredity, infection, diet, or environment. Answer? It fits.
Moreover, as a physician who, like my medical brethren, has had to resort to creative diagnostic coding to work with people in the field of weight management, I'm hoping that now, with a disease designation, these people will be able to have insurance to help defer some of the costs associated with obesity. This is particularly true of those who, on paper and exam, do not yet have the metabolic syndrome, but are clearly obese and seeking help.
Further, it is important that the medical community as well as the public and insurers drop their stereotypic perceptions of those who are obese, and elevate the obese condition to that of other disease conditions along with respect for those who are suffering. Finally, I hope this is a wake up call for public policymakers, as well as public and private funders to make certain comprehensive prevention and treatment resources are made available to all consumers.
Andrew Weil, MD, director, the Arizona Center for Integrative Medicine, University of Arizona
I do not consider obesity a disease. It is a condition, which may be associated with increased risk of certain diseases. It is possible to be obese and healthy, if one eats a balanced diet, gets regular physical activity, attends to other aspects of lifestyle that influence health, and makes use of appropriate preventive medical services.
Wayne Westcott, PhD, fitness research director, Quincy College
According to Merriam Webster’s College Dictionary (10th edition), disease is defined as a condition of the living animal or plant body or of one of its parts that impairs normal functioning. Based on this definition, obesity may be considered a disease at the point where it impairs normal body functioning. Of course, obesity is a precondition for diabetes, heart disease, low back pain, some types of cancer, and a variety of other diseases/disorders.
On the other hand, with more than one third of the American population presently classified as obese, it is clear that there are many causes for excessive fat accumulation (e.g., genetic issues, too little exercise/physical activity, too much food, inappropriate food selection, eating while watching television, etc.). In many cases, obesity is the result of a specific lifestyle which can typically be reversed (at least in the short term) by adopting a different lifestyle (e.g., more exercise/physical activity, lower calorie consumption, better food choices, less television snacking, etc.).
